Infectious diseases in healthcare workers - an analysis of the standardised data set of a German compensation board

Knowledge, attitudes, and practices of Jamaican healthcare workers on nosocomial infection control

Objectives

The emergence of deadly infections such as methicillin-resistant Staphylococcus aureus and COVID-19 (SARS-CoV-2) highlights the need for effective infection control (IC) procedures in healthcare facilities. The aim of the study was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) on IC procedures.

Methods

A cross-sectional survey was conducted among HCWs in western Jamaica from May to August 2015. A questionnaire based on the Jamaican Health Facilities Infection and Control Policies and Procedures Manual was used to collect data on staff training in IC, and their KAP of IC. Summary statistics, ANOVA, and multiple linear regression were applied for data analyses.

Results

Among 227 participants, the mean knowledge scores were statistically higher among the younger HCWs, Physicians/Nurses, and those in clinical units. Older HCWs, non-physicians/nurses, non-clinical unit workers, HCWs at Western Regional Hospital A, and those who received ongoing IC training scored higher on attitude. The practice scores were significantly correlated with the attitude scores but not the knowledge scores. The attitude score was a significant predictor for IC practices.

Conclusions

Six knowledge and three attitude variables were significant predictors of IC practices that the Western Regional Health Authority Officials can use to implement measures to improve IC practices among HCWs.

Awareness of standard precautions, circumstances of occurrence and management of occupational exposures to body fluids among healthcare workers in a regional level referral hospital (Bertoua, Cameroon)

BACKGROUND

Healthcare workers (HCW) are exposed to infectious agents within biological materials including blood, tissues, other body fluids and on medical supplies, contaminated surfaces within the care delivery environment. Trends in occupational injuries are influenced by the level of awareness and observance of standard precautions (SP) among HCWs. This study aimed to assess the level of awareness of SP, exposure to body fluids, reporting pattern and management among HCWs in a Referral Hospital.

METHODS

The present hospital-based cross-sectional study was carried out from 1st November 2020 to 31st May 2021. The exhaustive sampling method was used and a total of 120 consenting HCWs were invited to participate. A self-administered questionnaire addressed questions related to knowledge, experience, circumstances of exposure, reporting, management of occupational exposure to body fluids, hepatitis B vaccination status. Data were analyzed using R Statistic version 4.3.1. A p-value < 0.05 was considered significant.

RESULTS

Out of the 120 participating HCWs, 104 (86.7%) reported at least one accidental exposure to body fluids over the last year. Men (aOR = 4.19; p = 0.277) and HCWs aged 35 and over (aOR = 4.11; p = 0.114) were more at risk for AEB even though the difference was not statistically significant. Nurses/midwives (aOR = 65.9; p-value = 0.0005) and cleaners (aOR = 14.7; p-value = 0.0438) faced the highest risk of exposure. Lack of knowledge (79%) and patient agitation (49%) were the most reported reasons for exposure. Half of the participants (53%) reported that they used a personal protective equipment during care. Face mask (59.2%) and gowns (30.8%) were the most commonly used PPE. Most HCWs (62%) did not report AEB. Half of the affected HCWs (50.8%) received a course of post-exposure antiretroviral therapy. Few HCWs (4.2%) were fully immunized against Hepatitis B.

CONCLUSIONS

Most HCWs reported an accidental exposure to body fluids over the last year. Midwives and nurses were disproportionally affected socio-professional groups. Two-thirds of the AEB were undeclared. Only half of the participants reported using PPE systematically. Hepatitis B vaccination coverage was low. There is need to strengthen the observance of standard precautions, including preventive vaccination and the systematic reporting and management of AEB.

Prevalence of mental disorders and high rates of absenteeism from work among healthcare professionals in Slovenia: a retrospective study

OBJECTIVES

To investigate the prevalence of mental disorders and the higher rates of absenteeism from work among healthcare workers employed in Slovenia by analysing the prevalence of sick leave and medication prescriptions for treatment of mental health and behavioural disorders from 2015 to 2020.

DESIGN

Retrospective analysis of nationwide data on absenteeism and prescription of medications for treatment of mental health and behavioural disorders (anxiolytics, antipsychotics, antidepressants).

SETTING

National databases of the National Institute of Public Health in Slovenia.

PARTICIPANTS

All employed healthcare workers (35 008 in December 2020): dentists, midwives, nurses, nursing assistants, pharmacists and physicians in Slovenia from 2015 to 2020.

RESULTS

The most time spent on sick leave by male healthcare workers aged >50 was for 'neoplasms' (71.50 days on average), followed by 'mental health and behavioural disorders' (62.08 days on average). Female healthcare workers under 40 years old spent the most time on sick leave for 'pregnancy, childbirth, and the postpartum period (puerperium)', causing an average of 58.38 days of sick leave. From 2015 to 2020, the highest increase in prescribed medications for treatment of mental health and behavioural disorders was among nursing assistants (an increase of 38.42%), pharmacists (an increase of 29.36%) and nurses (an increase of 26.61%); since the COVID-19 pandemic, an increase of 12.36% was found among dentists, an increase of 11.51% among pharmacists and an increase of 11.36% among nurses.

CONCLUSION

The prescription of medications for treatment of mental health and behavioural disorders was on the rise from 2015 to 2020. The importance of employee health to individuals and society necessitates the systematisation of effective prevention programmes as well as programmes to assist those in need, especially health workers, whose work contributes significantly to maintaining public health.

Knowledge of Medical Imaging Professionals on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis

Healthcare-associated infections (HCAIs) are a significant concern for both healthcare professionals and patients. With recent advances in imaging modalities, there is an increase in patients visiting the radiology department for diagnosis and therapeutic examination. The equipment used for the investigator is contaminated, which may result in HCAIs to the patients and healthcare professionals. Medical imaging professionals (MIPs) should have adequate knowledge to overcome the spread of infection in the radiology department. This systematic review aimed to examine the literature on the knowledge and precaution standard of MIPs on HCIAs. This study was performed with a relative keyword using PRISMA guidelines. The articles were retrieved from 2000 to 2022 using Scopus, PubMed, and ProQuest databases. The NICE public health guidance manual was used to assess the quality of the full-length article. The search yielded 262 articles, of which Scopus published 13 articles, PubMed published 179 articles, and ProQuest published 55 articles. In the present review, out of 262 articles, only 5 fulfilled the criteria that reported MIPs' knowledge of Jordan, Egypt, Sri Lanka, France, and Malawi populations. The present review reported that MIPs have moderate knowledge and precautionary standards regarding HCIAs in the radiology department. However, due to the limited studies published in the literature, the current review limits the application of the outcome in the vast MIPs population. This review recommended further studies to be conducted among the MIPs worldwide to know the actual knowledge and precaution standards regarding HCIAs.

On-demand, remote and lossless manipulation of biofluid droplets

The recent global outbreaks of epidemics and pandemics have shown us that we are severely under-prepared to cope with infectious agents. Exposure to infectious agents present in biofluids (e.g., blood, saliva, urine etc.) poses a severe risk to clinical laboratory personnel and healthcare workers, resulting in hundreds of millions of hospital-acquired and laboratory-acquired infections annually. Novel technologies that can minimize human exposure through remote and automated handling of infectious biofluids will mitigate such risk. In this work, we present biofluid manipulators, which allow on-demand, remote and lossless manipulation of virtually any liquid droplet. Our manipulators are designed by integrating thermo-responsive soft actuators with superomniphobic surfaces. Utilizing our manipulators, we demonstrate on-demand, remote and lossless manipulation of biofluid droplets. We envision that our biofluid manipulators will not only reduce manual operations and minimize exposure to infectious agents, but also pave the way for developing inexpensive, simple and portable robotic systems, which can allow point-of-care operations, particularly in developing nations.

Elderly Caregiving Quality Improvement: A Pilot Study of the Burdens of Vietnamese Caregivers in Taiwan

Taiwan is expected to reach super-aged status by 2026, leading to an increased demand for elderly caregiving services. Low local unemployment and a dwindling working-age population mean the island's care system relies heavily on female foreign domestic workers (FDWs) from Southeast Asian neighbors such as Vietnam to satisfy labor shortages. Although suggested by anecdotal evidence, limited research has been conducted on the link between the shortfall in FDW qualifications, training, preparedness, and expertise and their employment stressors. Therefore, this study aims to assist FDWs by evaluating their stressors and helping them better understand health care delivery by (1) administering the Modified Caregiver Strain Index (MCSI) revised 2003 questionnaire, (2) performing semi-structured in-depth one-on-one interviews, (3) classifying interview results according to thematic analysis, and (4) using these themes to devise and deliver a 12-week multilingual health education teach-back program. Our results indicate that Vietnamese FDWs face specific challenges, including language barriers, homesickness, intensive physical and psychological work demands, stress adaptation, and occupational exposures. Despite yielding no significant improvements in caregiving strain, our intervention, conducted at the height of the COVID-19 pandemic, pinpoints and classifies areas of grave concern and proposes recommendations that can assist long-term care (LTC) stakeholders in understanding and overcoming their respective challenges, thereby improving the quality of elderly care.

Formulation of Chlorine-Dioxide-Releasing Nanofibers for Disinfection in Humid and CO2-Rich Environment

Background: Preventing infectious diseases has become particularly relevant in the past few years. Therefore, antiseptics that are harmless and insusceptible to microbial resistance mechanisms are desired in medicine and public health. In our recent work, a poly(ethylene oxide)-based nanofibrous mat loaded with sodium chlorite was formulated. Methods: We tested the chlorine dioxide production and bacterial inactivation of the fibers in a medium, modeling the parameters of human exhaled air (ca. 5% (v/v) CO2, T = 37 °C, RH > 95%). The morphology and microstructure of the fibers were investigated via scanning electron microscopy and infrared spectroscopy. Results: Smooth-surfaced, nanoscale fibers were produced. The ClO2-producing ability of the fibers decreased from 65.8 ppm/mg to 4.8 ppm/mg with the increase of the sample weight from 1 to 30 mg. The effect of CO2 concentration and exposure time was also evaluated. The antibacterial activity of the fibers was tested in a 24 h experiment. The sodium-chlorite-loaded fibers showed substantial antibacterial activity. Conclusions: Chlorine dioxide was liberated into the gas phase in the presence of CO2 and water vapor, eliminating the bacteria. Sodium-chlorite-loaded nanofibers can be sources of prolonged chlorine dioxide production and subsequent pathogen inactivation in a CO2-rich and humid environment. Based on the results, further evaluation of the possible application of the formulation in face-mask filters as medical devices is encouraged.

A QUALITATIVE STUDY ON THE BIOLOGICAL HAZARDS ASSOCIATED WITH MORTUARY WORK: THE GHANAIAN PERSPECTIVE

BACKGROUND

Workplace safety and health are significant public health concerns for maintaining a low-risk environment. In Africa and Ghana, most mortuaries are not well resourced, nor do they follow the universal standard precautions for infection prevention. As a result, it exposes mortuary attendants to numerous biological hazards that threaten their health and well-being and cause anxiety of contracting infectious diseases while attending to corpses.

OBJECTIVES

The study sought to explore the biological hazards to which mortuary attendants in Ghana are exposed in three selected regions.

METHODS

Qualitative research approach was used together with an exploratory, descriptive design. Semi-structured interviews were conducted to comprehend the biological hazards among mortuary attendants. Purposive sampling was used, and saturation was reached with nineteen participants.

RESULTS

The study revealed that most mortuary attendants were exposed to infections through direct contact with bodily fluids. Exposure to potentially contaminated syringes and needles due to non-adherence to universal standard precautions for corpse handling and the poor condition of storage systems as well as work environment were found to facilitate the risk of infection.

CONCLUSION AND RECOMMENDATION

This study shows that mortuary attendants are exposed to biological hazards like HIV and other blood-borne diseases, making them hesitant to work and have difficulty concentrating on their jobs. The study recommends the urgent provision of functioning cold rooms to preserve the integrity of the corpses, PPE, and adequate training of mortuary attendants on universal standard precautions to enhance safe and therapeutic working environments.

Mind the gap: From recommendation to practice in crisis management. Exploring the gap between the "lessons identified" during exercise cygnus and the UK government response to COVID-19

The failure to learn lessons from crises is a common observation. The UK Government has been criticized for its response to the COVID-19 crisis. Many critics have highlighted the Government's apparent failure to learn the lessons from Exercise Cygnus, which made recommendations to improve the UK's response to a pandemic. This article compares and contrasts the UK Government's response with the exercise recommendations. It critiques the gaps using current crisis management literature and argues that to avoid future failings, more emphasis is needed on the effectiveness of recommendations from exercises. If this is not done, exercise lessons identified, and their recommendations will not be operationalized. This article argues that the successful transition from policy recommendation to practice requires recommendations to be contextualized, so they are feasible and practical, before they can be institutionalized. It introduces a practical framework and organizational actions on how future exercises can close the gap from lessons identified to be learned and shape practice.

Impact of occupational exposure to COVID-19 on the physical and mental health of an essential workgroup: New York City transit workers

Background and purpose

Early on in the COVID-19 pandemic, New York City (NYC) vowed to “keep the subways running” despite the lack of plans in place for protecting the health and well-being of transit workers. This study was designed to assess the impact of employment during the early phase of the pandemic on this essential frontline workforce.

Methods, settings, and study participants

A convenience sample of members (stratified by job title) of the NYC Transport Workers Union, Local 100, was recruited in August 2020 to participate in an anonymous, cross-sectional, internet-based survey.

Results

The demographics of the sample participants (N = 645) reflected union membership, ie, 82 percent male, 29 percent Black; 27 percent Hispanic, and 59 percent ≥age 50 years. At the time of the “NYC Pause” (March 22, 2020) when mandatory stay-at-home orders were issued, transit workers had limited worksite protections. Many reported a lack of such basics as face masks (43 percent), hand sanitizer (40 percent), and disposable gloves (34 percent). A high proportion (87 percent) were concerned about getting infected at work. Lack of certain protections was significantly associated with both fear of contagion at work and mental health symptoms. Nearly 24 per­cent of participants reported a history of COVID-19 infection. Self-reported infection was significantly correlated with lack of certain protections, including respiratory masks (p < 0.001), disposable gloves (p < 0.001), and hand sanitizer (p < 0.001). Infection was also significantly associated with mental health symptoms (p < 0.001). By August 2020, despite participants reporting that many worksite protections were then in place, 72 percent of workers were still fearful for their safety at work, eg, because of potential exposure due to passengers not wearing masks, and risk of verbal abuse and physical assault by passengers angered when asked to wear face masks. Workers who were fearful for their safety at work were more than six times more likely to report mental health symptoms (p < 0.001).

Conclusions

Lack of worksite protections before “NYC Pause” (March 22, 2020) was significantly associated with self-reported infection, fear, and mental health symptoms in TWU, Local 100 members. To reduce the risk of adverse impacts associated with bioevents in all essential work groups, and across all essential occupational settings, infection control preparedness, early recognition of risk, and implementation of tailored risk reduction strategies are imperative. Pandemic preparedness is fundamental to protecting the health and well-being of essential workers and crucial in controlling the spread of disease in the community. Bioevent preparedness for all essential frontline workgroups will also help reduce occupational health inequities. Workers at risk, regardless of setting, deserve and have the right to equal protections under federal and state law.

Occupational Skin Disease in Physicians: A Review of the Literature

OBJECTIVES

Occupational skin disease (OSD) arises from work-related activity. However, there is a paucity of literature on OSD in physicians. The aim of the this review was therefore to examine and summarize what types of symptomatic OSD physicians experience.

METHODS

We conducted a systematic literature search on Cochrane Library, Embase, and Pubmed.

RESULTS

Contact dermatitis from formaldehyde and glutaraldehyde were found in 11.5 and 13.5% of cases, respectively. In total 2.4-14.9% had latex allergy. The reported standardized incidence ratio of squamous cell carcinoma and melanoma was up to 2.15 [95% confidence interval (CI) 1.57-1.95] and 3.2 (95% CI 1.38-6.31). Transmission of human papilloma virus (HPV) particles during carbon dioxide laser wart ablation were found in 70% of samples collected from protective gloves and in 52% of samples from vapors.

CONCLUSIONS

The most frequently reported OSD in physicians is contact dermatitis from allergens in disinfectants and rubber gloves. There is also a risk of cutaneous reactions to latex. The incidence of skin cancer was higher in physicians than in the general population, and the reason for this remains unexplained and potentially biased. There are no reports of transmission of patient HPV to surgeons during wart ablation, possibly because of proper use of protective equipment.

"We All Really Need to just Take a Breath": Composite Narratives of Hospital Doctors' Well-Being during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to the physical and mental well-being of doctors worldwide. Countries around the world introduced severe social restrictions, and significant changes to health service provision in the first wave of the pandemic to suppress the spread of the virus and prioritize healthcare for those who contracted it. This study interviewed 48 hospital doctors who worked in Ireland during the first wave of the pandemic and investigated their conceptualizations of their own well-being during that time (March-May 2020). Doctors were interviewed via Zoom™ or telephone. Interview transcripts were analyzed using structured thematic analysis. Five composite narratives are presented which have been crafted to illustrate themes and experiences emerging from the data. This study found that despite the risks of contracting COVID-19, many doctors saw some improvements to their physical well-being in the first wave of the pandemic. However, most also experienced a decline in their mental well-being due to anxiety, emotional exhaustion, guilt, isolation and poor support. These findings shed light on doctor well-being during COVID-19, and the ways in which they have been affected by the pandemic, both professionally and personally. The paper concludes by highlighting how doctors' work life and well-being can be better supported during and after the COVID-19 pandemic.

Absence of nosocomial transmission of coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in the prepandemic phase in Hong Kong

Background

To describe the infection control strategy to achieve zero nosocomial transmission of symptomatic coronavirus disease (COVID-19) due to SARS-CoV-2 during the prepandemic phase (the first 72 days after announcement of pneumonia cases in Wuhan) in Hong Kong.

Methods

Administrative support with the aim of zero nosocomial transmission by reducing elective clinical services, decanting wards, mobilizing isolation facilities, providing adequate personal protective equipment, coordinating laboratory network for rapid molecular diagnosis under 4-tier active surveillance for hospitalized patients and outpatients, and organizing staff forum and training was implemented under the framework of preparedness plan in Hospital Authority. The trend of SARS-CoV-2 in the first 72 days was compared with that of SARS-CoV 2003.

Results

Up to day 72 of the epidemic, 130 (0.40%) of 32,443 patients being screened confirmed to have SARS-CoV-2 by reverse transcription polymerase chain reaction. Compared with SARS outbreak in 2003, the SARS-CoV-2 case load constituted 8.9% (130 SARS-CoV-2/1458 SARS-CoV) of SARS-CoV infected cases at day 72 of the outbreak. The incidences of nosocomial acquisition of SARS-CoV per 1,000 SARS-patient-day and per 100 SARS-patient-admission were 7.9 and 16.9, respectively, which were significantly higher than the corresponding incidences of SARS-CoV-2 (zero infection, P <.001).

Conclusions

Administrative support to infection control could minimize the risk of nosocomial transmission of SARS-CoV-2.

Risk Analysis of Latent Tuberculosis Infection among Health Workers Compared to Employees in Other Sectors

Latent tuberculosis infection (LTBI) represents a work-related risk for health workers (HWs). Tuberculosis remains the second most common occupational infectious disease among HWs in Germany. Comparative figures on LTBI prevalence in the general population are missing because testing is only carried out in the context of an outbreak situation. The objective of this study is to investigate whether HWs are at greater risk of LTBI than workers in other sectors. This study is based on two samples. The first sample is a database of HWs who were examined by the German Occupational Physicians Network using an interferon-gamma release assay (IGRA). The second sample consists of general employees (non-health workers, non-HWs) from Hamburg who had no professional contact with the health care system. Propensity score matching (PS matching) was performed to ensure better comparability of the groups. The differences in the prevalence of positive test results from IGRAs were examined using univariate and multivariate analyses. After the PS matching of 1:10, 100 test subjects in the non-HW group and 1000 HWs remained to form the analysis collective. The HWs tended to exhibit higher IGRA values than non-HWs. The univariate analysis showed an odds ratio (OR) of 3.86 for the HWs (95% confidence interval (CI): 0.99 to 32.5; p = 0.056) with respect to a positive test result. The multivariate analysis produced an OR of 4.92, (95% CI: 1.3 to 43.7; p = 0.013) for HWs born in Germany. Despite the declining tuberculosis incidence rates in Germany, a comparison with non-exposed professional groups showed that HWs are at greater risk of LTBI. Preventive medical check-ups still seem to be indicated.

A Systematic Review of Healthcare-Associated Infectious Organisms in Medical Radiation Science Departments

Healthcare-associated infections (HAIs) pose a significant occupational risk to medical radiation science (MRS) professionals, who have a high degree of patient contact. Current research largely focusses on HAIs in patients, with limited attention given to infectious organisms that MRS professionals are exposed to. This is a significant gap that this systematic review seeks to address by summarizing current literature to determine the infectious organisms within MRS departments, their reservoirs, and transmission modes. Reporting of this systematic review follows the preferred reporting items for systematic reviews and meta-analyses guidelines. Five databases were searched (Scopus, Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Library, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) for relevant studies published between 1983 and 2018. Quality assessment was performed using checklists from the Johanna Briggs Institute. Nineteen studies were included in the review; twelve of which were set in diagnostic radiography departments, two in radiotherapy departments, and five in non-MRS departments. No studies were set in nuclear medicine departments, indicating a gap in the available literature. A total of 19 genera of infectious organisms were identified in the literature, with Staphylococcus, Escherichia, Bacillus, and Corynebacterium reported in all MRS departments. Infectious organisms were identified in all observational studies, indicating a need for better infection control methods and/or compliance training within MRS to minimize the risk of infections.

Tuberculosis among Health Workers-A Secondary Data Analysis of German Social Accident Insurance Data from 2002-2017

Tuberculosis (TB) is the most common cause of fatal infections worldwide. Recent TB figures in Europe indicate that 30 people were infected with tuberculosis each hour in 2017. Healthcare workers are at particular risk of being infected through patient contact. TB is the second most common occupational infectious disease among German healthcare workers. Routine data from the German Social Accident Insurance were used to examine trends in occupational TB diseases. We analyzed annual cross-sectional data for the years 2002 to 2017. The data underwent descriptive analysis. A total of 4653 TB cases were recognized as occupational diseases (OD) in the period under study. In 2002, 60 TB cases were recognized as OD No. 3101, i.e., transmissions from person to person. Since 2013, the level has settled at around 500 recognized cases per year. This is around eight times the number of cases compared to 2002. The following three groups collectively accounted for the largest share of TB cases (88.5%): nurses (including geriatric nurses), other healthcare employees, and physicians. The upward trend in the number of TB cases recognized as occupational diseases is probably due to improvements in diagnostic tests used to diagnose TB infections. TB in health and welfare workers remains an important issue in the health and welfare sector in Germany, partly due to the long latency period between potential exposure to infectious patients or materials and the recognition of the latent tuberculosis infection (LTBI) or active TB as OD.

Cost-Effectiveness Analysis of Direct-Acting Antiviral Agents for Occupational Hepatitis C Infections in Germany

Around 1% of the world's population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel (HP) with confirmed occupational diseases in Germany. A standardised database from a German statutory accident insurance was used to analyse the cost-effectiveness ratio for the DAA regimen in comparison with interferon-based triple therapies. Taking account of the clinical progression of the disease, a Markov model was applied to perform a base case analysis for a period of 20 years. The robustness of the results was determined using a univariate deterministic sensitivity analysis. The results show that treatment with DAAs is more expensive, but also more effective than triple therapies. The model also revealed that the loss of 3.23 life years can be averted per patient over the 20 years. Compared to triple therapies, DAA treatment leads to a higher sustained virologic response (SVR). Although this results in a decrease of costs in the long term, e.g., pension payments, DAA therapy will cause greater expense in the future due to the high costs of the drugs.

Occupational adverse effects and protective factors in bronchoscopy

The application of bronchoscopy has resolved a series of diagnostic and treatment challenges in pulmonary diseases. However, the occupational adverse effects experienced by healthcare workers in interventional pulmonology should receive increasing attention. Various aspects of adverse effects in bronchoscopy are often neglected, and healthcare workers frequently ignore guidelines for personal protection against factors such as radiation, smoke, pathogenic microbiological aerosols, cryogenic gas, etc. Thus, there is an urgent need to conduct additional research to establish standards for occupational adverse effects and protective measures related to bronchoscopy.

Infections in Healthcare Workers in Germany-22-Year Time Trends

Health workers (HWs) run an increased risk of infection. The standardised data set of an accident insurer was used to analyse the time trends of infection-related claims and confirmed occupational diseases (ODs) in HWs. The numbers of claims and confirmed claims for different infections were analysed for the years 1996 to 2017. The rate of claims and confirmed ODs were calculated per 100,000 full-time workers. The number of claims was relatively stable over time. However, the rate per 100,000 full-time workers decreased from 25.2 to 15.4. The decrease was most pronounced for hepatitis B and hepatitis C infections, which were the most frequent infections for which claims were made at the start of the period. In 2017, tuberculosis (TB)-related claims were more frequent than those related to blood-borne virus infections. However, the growing number of TB claims does not reflect an increased infection risk, but rather improved methods for the diagnosis of latent TB infection (LTBI). Measures to prevent blood-borne virus infections in HWs were successful in the last 22 years, but attention should be paid to newly emerging infections.

Incidence of Newly Diagnosed Tuberculosis among Healthcare Workers in a Teaching Hospital, Thailand

BACKGROUND

Data on the incidence of new onset tuberculosis (TB) infection among healthcare workers (HCWs) in Thailand was scarce and not current.

OBJECTIVES

To determine the incidence of TB, as well as the impact of TB on HCWs in a teaching hospital in Bangkok, Thailand.

METHODS

A time series cross-sectional study was conducted at Ramathibodi Hospital, Bangkok, Thailand. It was a teaching hospital with 9,562 employees. Medical records of personnel with TB infection between October 1st, 2010 and September 30th, 2015 were reviewed to determine the newly diagnosed TB infection. The personnel who were treated in fiscal year 2015 were interviewed about work-related issues, health status and the impact of TB.

FINDINGS

In five years, 109 personnel were diagnosed with new onset TB disease. The infection rates were 2.04, 1.97, 2.85, 2.53, and 1.35 per 1,000 persons in 2011, 2012, 2013, 2014, and 2015, respectively. The most prevalent type of TB infection was pulmonary TB. The infection rate in males was higher than in females. Pharmacists had the highest proportion of infected personnel. The second highest rate of infection was in support staff related to patient care. Twenty personnel were interviewed. Most of them worked in patient care units with central-type air-conditioning system without negative-pressure rooms for TB patients. Contracting TB had an impact on productivity at work, health (physically, mentally and socially) and incomes.

CONCLUSIONS

Ramathibodi HCWs had higher rate of TB infection than the general Thai population, but the incidence was noted to be decreasing from 2013 to 2015. HCWs suffered from the impact of TB on their lives in multiple ways. Due to the adverse impact of TB on the health and welfare of its employees, hospital administration should apply effective preventive measures and develop a compensation system for HCWs infected with TB.

Hepatitis C in healthcare personnel: secondary data analysis of therapies with direct-acting antiviral agents

Background

Hepatitis C Virus (HCV) infections are blood-borne, generally chronic and are associated with increased morbidity and mortality. The aim of this study is to describe the results of therapies with direct-acting antiviral agents (DAAs) in healthcare personnel.

Methods

Secondary data analysis using data from the Statutory Accident Insurance of the Health and Welfare Service. The study surveyed DAA therapies administered to insured parties (healthcare personnel with an HCV infection recognised as an occupational disease) in Germany between 01/01/2014 and 30/11/2016. The end points were results of monitorings carried out twelve weeks after the end of treatment (SVR12), side effects and the results of the assessment of reduced work ability after treatment. Multivariate logistic regression models were constructed to model SVR12.

Results

The study population (n = 180) comprised 74% women, 90% of the participants had an HCV genotype 1 infection. Two-thirds had fibrosis or cirrhosis and were treatment experienced. The most common combined therapy was ledipasvir and sofosbuvir (49%). A DAA therapy with ribavirin was administered in 20% of cases, with (pegylated) interferon and ribavirin used in 2% of cases. The majority of therapies were completed without any side effects. The overall SVR12 rate was 94%. Significant independent predictor of decrease odds of SVR12 was liver cirrhosis. Positive effects on the healthcare personnel’s work ability were observed after successful therapy.

Conclusion

High SVR12 rates were achieved in the sample population, with positive effects on their work ability. Early HCV therapy seems reasonable due to the increased chance of successful treatment of the infection.

Electronic supplementary material

The online version of this article (10.1186/s12995-018-0197-6) contains supplementary material, which is available to authorized users.

Hepatitis C among healthcare personnel: secondary data analyses of costs and trends for hepatitis C infections with occupational causes

Background

Hepatitis C infection is a global public health issue. Chronic hepatitis C infection is associated with significant morbidity and mortality. The aim of this study is to describe the costs for occupationally-cased hepatitis C infections based on data from an accident insurance carrier.

Methods

This study is a secondary analysis based on the Database of a German Institution for Statutory Accident Insurance. The analysis is based on a sample of insured parties whose hepatitis C infections were recorded as occupational diseases between 1996 and 2013. The analysis is based on recognised hepatitis C cases and incorporates records registered between 1 January 2000 and 31 December 2014.

Results

Within the study period, the number of reported and recognised hepatitis C cases declined by 73 and 86% respectively. The majority of recognised hepatitis C cases (n = 1.121) were female, older than 40 years and were active in a medical nursing profession. In the study period, the costs came to a total of € 87.9 million, of which 60% was attributable to pension payments (€ 51,570,830) and around 15% was attributable to pharmaceutical and medicinal products (€ 12,978,318). Expenses for drugs exhibited heavy increases in 2012 (from around € 500,000–800,000 to € 1.7 million) and 2014 (to € 2.5 million) in particular. Pension payments came to € 1.6 million in 2000 and rose continuously to over € 4 million in 2014. Expenses for occupational rehabilitation accounted for less than 1%.

Conclusions

For hepatitis C infections as an occupational disease, a considerable increase in costs has been observed in recent years, while the number of reports has declined heavily. This rise in costs is explained by the increase in pension payments and, since 2012, by a rise in the costs for drugs. The high costs of anti-viral therapies is offset by the potential for considerable treatment benefits. Healing the infection is expected to generate long-term cost savings for statutory accident insurance carriers, and also for social security systems.

The prevalence of hepatitis C among healthcare workers: a systematic review and meta-analysis

The aim of this study was to estimate the prevalence of viral hepatitis C (HCV) infection among healthcare workers (HCWs) compared to the general population. A systematic search for the years 1989–2014 was conducted in the Medline, Embase and Cochrane databases. Studies on hepatitis C in HCWs were included if they incorporated either a control group or reference data for the general population. The study quality was classified as high, moderate or low. Pooled effect estimates were calculated to determine the odds of occupational infection. Heterogeneity between studies was analysed using the χ² test (p<0.10) and quantified using the I² test. 57 studies met our criteria for inclusion and 44 were included in the meta-analysis. Analysis of high and moderate quality studies showed a significantly increased OR for HCV infection in HCWs relative to control populations, with a value of 1.6 (95% CI 1.03 to 2.42). Stratification by study region gave an OR of 2.1 in low prevalence countries; while stratification by occupational groups gave an increased prevalence for medical (OR 2.2) and for laboratory staff (OR 2.2). The OR for professionals at high risk of blood contact was 2.7. The pooled analysis indicates that the prevalence of infection is significantly higher in HCWs than in the general population. The highest prevalence was observed among medical and laboratory staff. Prospective studies that focus on HCW-specific activity and personal risk factors for HCV infection are needed.

What do healthcare workers in elderly care know about occupational health and safety? An explorative survey

BACKGROUND

Demographic changes will lead to a growing demand for healthy, motivated healthcare workers (HCW) in the years ahead. Along with well-targeted prevention, knowledge of occupational health and safety and infection precaution is essential for a healthy working life. In this context back-friendly working methods and protection from infectious diseases are necessary in elderly care.

METHODS

In 2012, a survey was conducted in nine residential and two semi-residential nursing homes, as well as in one home care service in the Schwerin area of northeast Germany. Four hundred and seventy three HCWs were asked to fill in a questionnaire on what they knew about aspects of occupational health and safety such as vaccinations and preventative measures administered by occupational physicians, hygiene, back-friendly working methods and infection prevention. The statistical evaluation was descriptive, with a comparison between job title. Differences were examined with chi square or Fisher's exact test.

RESULTS

The response rate was 28 % (n = 132). The largest group of respondents (36 %) were qualified geriatric HCWs. More than 74 % of employees felt well informed about opportunities for precautionary checks and vaccination by occupational physician, and 93 % utilized these opportunities. When it came to assigning modes of transmission to specific infectious diseases, only 23 % of participants were well informed, and one in three (31 %) care assistants was inadequately informed. Fewer than half of participants could correctly name the indications for hand disinfection. Only 66 % of the HCWs said they were aware of training offers for the management of multidrug-resistant organisms in their institution. They did know about possible aids to back-friendly working, although gaps in knowledge were apparent. Only 59 % of respondents knew that care utensils should preferably be stored at working height so as to reduce awkward body postures.

CONCLUSIONS

Employees in elderly care are well informed about the range of precautionary occupational medical examinations and take advantage of this offering. Questions in the survey regarding hygiene management were answered in a competent manner. On the other hand some gaps in the knowledge about infection prevention and occupational safety became apparent. Differences between qualified and unqualified participating professionals occurred only in the knowledge of infectious diseases and pathogens and the associated path of infection. The extent to which training can help to improve infection prevention and occupational health and safety should be investigated.

Occupational screening for tuberculosis and the use of a borderline zone for interpretation of the IGRA in German healthcare workers

Introduction

Healthcare workers (HCWs) in low incidence countries with contact to patients with tuberculosis (TB) are considered a high-risk group for latent TB infection (LTBI) and therefore are routinely screened for LTBI. The German Occupational TB Network data is analyzed in order to estimate the prevalence and incidence of LTBI and to evaluate putative risk factors for a positive IGRA and the performance of IGRA in serial testing.

Methods

3,823 HCWs were screened with the Quantiferon Gold in Tube (QFT) at least once; a second QFT was performed on 817 HCWs either in the course of contact tracing or serial examination. Risk factors for a positive QFT were assessed by a questionnaire.

Results

We observed a prevalence of LTBI of 8.3%. Putative risk factors for a positive QFT result were age >55 years (OR 6.89), foreign country of birth (OR 2.39), personal history of TB (OR 6.23) and workplace, e.g. internal medicine (OR 1.40), infection ward (OR 1.8) or geriatric care (OR 1.8). Of those repeatedly tested, 88.2% (721/817) tested consistently QFT-negative and 47 were consistently QFT-positive (5.8%). A conversion was observed in 2.8% (n = 21 of 742 with a negative first QFT) and a reversion occurred in 37.3% (n = 28 of 75 with a positive first QFT). Defining a conversion as an increase of the specific interferon concentration from <0.2 to >0.7 IU/ml, the conversion rate decreased to 1.2% (n = 8). Analogous to this, the reversion rate decreased to 18.8% (n = 9).

Discussion

In countries with a low incidence of TB and high hygiene standards, the LTBI infection risk for HCWs seems low. Introducing a borderline zone from 0.2 to ≤0.7 IU/ml may help to avoid unnecessary X-rays and preventive chemotherapy. No case of active TB was detected. Therefore, it might be reasonable to further restrict TB screening to HCWs who had unprotected contact with infectious patients or materials.

Occupational accident and disease claims, work-related stress and job satisfaction of physiotherapists

INTRODUCTION

Physiotherapists are exposed to diverse occupational demands. Until now, little has been known about the interaction between occupational stress and the job satisfaction of physiotherapists. This paper aims to examine their work-related stress and job satisfaction. It will analyse accidents at work and occupational diseases of physiotherapists along with work-related physical and psychosocial stress and job satisfaction.

METHOD

We analysed routine data of the German Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) on accidents at work and occurring en route to/from work as well as occupational diseases of physiotherapists. Work-related stress and job satisfaction were examined in a cross-sectional survey using a standard questionnaire to be completed by subjects themselves.

RESULTS

Between 2007 and 2011, 1,229 cases of occupational disease were reported to the BGW. The majority of reports involved skin diseases (73%). Stumbles and falls were the most frequent causes of accidents at work (42.9%). Eighty-five physiotherapists all over Germany took part in the survey. They experience high quantitative demands at work. The main physical demands consist of a torso posture between 45° and 90° and high hand activity. Of the 85 subjects, 51% suffer from complaints of the musculoskeletal system in the neck and thoracic spine area and 24% have skin diseases. Most physiotherapists (88%) are satisfied with their work overall. This is aided by a high degree of influence on their work and breaks, by practical application of skills and expert knowledge, high regard for their profession, varied work and a good atmosphere at work. Reservations tend to be about statutory regulations and the social benefits provided by the German healthcare system.

CONCLUSION

Overall, despite high demands and stress relating to the adequacy of resources, the majority of physiotherapists surveyed seem to be satisfied with their job. The main focus of action to promote the health of physiotherapists should be on preventing skin disease, problems of the musculoskeletal system and accidents caused by stumbles and falls.

Prevalence of latent tuberculosis infection and associated risk factors among 3,374 healthcare students in Italy

Introduction

The risk of tuberculosis (TB) in healthcare personnel (HCP) is related to its incidence in the general population. Healthcare students involved in clinical training could be exposed to occupational risks similar to those that HCP face. The prevalence of latent tuberculosis infection (LTBI) among undergraduate healthcare students with different working seniority in Italy was analysed.

Methods

A cross-sectional study under a screening programme for LTBI among undergraduate and postgraduate students attending Medical School at the Second University of Naples was conducted between January 2012 and December 2013 with clinical evaluations, tuberculin skin testing (TST) and, in positive TST students, Interferon-γ release assays (IGRA). Putative risk factors for LTBI were assessed by means of a standardised questionnaire.

Results

3,374 students attending the Medical School of the Second University of Naples were submitted to a screening programme for TBC. 3,331 performed TST as a first-level test and 43 performed a Quantiferon test (QFT). 128 students were TST-positive and continued the diagnostic work with QFT, which was positive in 34 students. Of the 43 subjects who took the QFT as a first-level test only 1 was positive. In 35 students positive to the QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. A correlation was found between age, non-Italian born persons, studying age, post-medical school status and LTBI.

Conclusions

The prevalence of LTBI among healthcare students in our study was very low. In countries with a low incidence of TB, the screening programmes of healthcare students can be useful for early identification and treatment of sporadic cases of LTBI.

Electronic supplementary material

The online version of this article (doi:10.1186/s12995-014-0034-5) contains supplementary material, which is available to authorized users.

Healthcare workers' occupational exposure to bloodborne pathogens: a 5-year observation in selected hospitals of the Małopolska province

OBJECTIVES

The study presents data concerning occupational exposures among the staff of 5 hospitals in the Małopolska province in 2008-2012, taking into account the frequency and circumstances of exposure formation, occupational groups of hospital workers, as well as diversification of the reported rates in subsequent years between the hospitals and in each of them. An additional objective of the analysis was to assess the practical usefulness of the reported data for planning and evaluation of the effectiveness of procedures serving to minimize the risk of healthcare workers' exposure to pathogens transmitted through blood.

MATERIAL AND METHODS

Data were derived from occupational exposure registries kept by 5 hospitals of varying sizes and operational profiles from the Małopolska province from the years 2008-2012.

RESULTS

Seven hundred and seventy-five cases of exposure were found in a group of 3165 potentially exposed workers in the analyzed period. Most cases were observed in nurses (68%) and these were mainly various types of needlestick injuries (78%). Exposure rates with respect to all workers ranged from 2.6% to 8.3% in individual hospitals, but the differences in their values registered in the hospitals in subsequent years did not bear any statistical significance, in a way similar to the rates calculated separately for each occupational group.

CONCLUSIONS

There was no upward or downward trend in the number of reported cases of exposure to bloodborne pathogens in the studied period in any of the hospitals. Statistically significant differences in the percentages of exposures were reported between individual hospitals in some years of the analyzed period, which confirms the need for registries in individual units in order to plan and evaluate the effectiveness of preventative measures.

Tuberculosis in healthcare workers - a narrative review from a German perspective

Introduction

Despite the decline of tuberculosis in the population at large, healthcare workers (HCW) are still at risk of infection.

Methods

In a narrative review the TB risk in HCW and preventive measures are described, with the focus on epidemiology and Occupational Safety and Health (OSH) regulations in Germany.

Results

There is an increased risk of infection not only in pneumology and laboratories with regular contact with tuberculosis patients or infectious materials. Epidemiological studies have also verified an increased risk of infection from activities that involve close contact with patients’ breath (e.g. bronchoscopy, intubation) or close contact with patients in need of care in geriatric medicine or geriatric nursing. In occupational disease claim proceedings on account of tuberculosis, the burden of proof can be eased for insured persons who work in these or other comparable fields. Forgoing evidence of an index person as a source of infection has led to a doubling of the rate of cases of tuberculosis recognised as an occupational disease and has halved the duration of occupational disease claim proceedings in Germany. For several years now, it has been possible to use the new interferon-y release assays (IGRAs) to diagnose a latent tuberculosis infection (LTBI) with significantly greater validity than with the traditional tuberculin skin test (TST). However, variability of the IGRAs around the cut-off poses problems especially in serial testing of HCWs. At around 10%, LTBI prevalence in German healthcare workers is lower than had been assumed. It can make sense to treat a recent LTBI in a young healthcare worker so as to prevent progression into active tuberculosis. If the LTBI is occupational in origin, the provider of statutory accident insurance can cover the costs of preventive treatment. However, little is known about disease progression in HCWs with positive IGRA sofar.

Conclusion

TB screening in HCWs will remain an important issue in the near future even in low incidence, high income countries, as active TB in HCWs is often due to workplace exposure. The IGRAs facilitate these screenings. However, variability of IGRA results in serial testing of HCWs need further investigations.

Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire

Background

Work in dialysis facilities involves long term contact with chronically ill patients. International comparisons make it clear that dialysis work is being concentrated, staff is being reduced and more patients are being treated. It is more than 20 years since the last German publication on job strains and job satisfaction experienced by dialysis staff was published. The present study examines the stress and strain currently experienced by the staff of German dialysis facilities.

Methods

The staff of 20 dialysis facilities were surveyed with the Copenhagen Psychosocial Questionnaire (COPSOQ). The questionnaire was extended by adding dialysis-specific questions. The data from the dialysis facilities were assessed by comparison with other professions in medical care - nurses and geriatric nurses - using data recorded in the German COPSOQ database.

Results

A total of 367 employees took part in the study, corresponding to a response rate of 55%. For almost all psychosocial aspects, the dialysis staff regarded the stress and strain as being more critical than did the geriatric nurses. There were some positive differences in comparison to hospital nursing, including less conflict between work and private life. However, there were also negative differences, such as fewer possibilities of influencing the work.

Conclusions

The results of the study show that dialysis work exhibits both positive and negative aspects in comparison with other healthcare professions. The results in the different facilities were highly variable, indicating that the deficits found in the individual scales are not inevitable consequences of working in dialysis in general, but are influenced and might be favourably altered by the individual facilities.

HCV transmission in industrialized countries and resource-constrained areas

HCV is a blood-borne virus transmitted by percutaneous exposure to infected blood or blood-derived body fluids. The main routes of transmission are blood transfusions, medical procedures and injection drug use. In industrialized countries, HCV transmission through blood transfusions has been virtually eliminated and iatrogenic transmission occurs only sporadically during local breaches of infection control procedures. As most new cases originate from injection drug use, harm-reduction programmes (including opiate substitution, needle exchange and health education) can greatly reduce HCV transmission. Currently, the main approach to reduce the HCV disease burden is by increasing awareness of both the public and health-care providers to hepatitis C, enhancing screening opportunities and treatment of the infected population. In resource-limited countries, the priority is reducing transmission through blood transfusions and invasive medical procedures. This approach requires training of health-care providers and also structural changes and financial investments in countries where antibody screening, disposable materials and effective sterilization procedures are not routinely available. In these countries, reducing the HCV burden has been hampered by limited access to treatment, largely owing to the cost of drugs. Access to treatment is moving up on the agenda of international and non-governmental organizations in conjunction with the future availability of highly efficacious oral drug regimens.

Reduction of needlestick injuries in healthcare personnel at a university hospital using safety devices

Background

Healthcare personnel (HCP) is exposed to bloodborne pathogens through occupational risk factors. The objective of this study was to compare the incidence of needlestick injuries (NSIs) before and after the introduction of safety devices in all departments of our hospital.

Methods

Data was extracted from mandatory needlestick report forms of the hospital’s Occupational Health Service. Serological results of patients and healthcare personnel (HCP) were reviewed in the laboratory information system.

Results

In 2007, the year before the introduction of safety devices, 448 needlestick injuries were self-reported, corresponding to an annual rate of 69.0 NSIs per 1 000 full-time HCP. The highest incidence was observed among medical staff in the surgery department and internal medicine with 152 (33.9%) and 79 (17.6%) NSIs, respectively. Of all occupational groups, nurses (36.2%) had the highest risk to sustain NSIs. In 2008 safety devices were introduced across the hospital, e.g. peripheral venous catheter, hypodermic needle and stapling system for wound sealing providing active or passive protection. In 2009, the year after introduction of safety devices, only 350 NSIs were reported, the annual rate of NSIs decreased to 52.4 per 1 000 full-time HCP. Thus an overall reduction of 21.9% for NSIs was achieved when safer devices were applied. The number of NSIs was reduced by even 50% for blood withdrawal, for use of peripheral venous catheters and application of hypodermic needles.

Conclusion

The application of safety devices led to a reduction of NSIs and significantly reduces the risk of bloodborne infections.